망막정맥폐쇄 환자에서 유리체강 내 덱사메타손 임플란트삽입술시행 후 안압 변화
Intraocular Pressure Changes in Patients with Retinal Vein Occlusion Treated with Intravitreal Dexamethasone Implant Insertion
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목적: 망막정맥폐쇄로 유리체강 내 덱사메타손 삽입술을 시행한 환자에서 안압 상승과 그 경과에 대해 알아보고자 한다. 대상과 방법: 2011년 2월부터 2017년 3월까지 망막정맥폐쇄로 인한 황반부종으로 유리체강 내 덱사메타손 삽입술을 시행한 환자 중본 연구에서 설정한 기준에 부합하고 3년 이상 경과관찰이 가능했던 32명(32안)을 대상으로 의무기록을 이용한 후향적 연구를 시행하였다. 결과: 유리체강 내 덱사메타손 삽입술 후 안압이 25 mmHg 이상으로 상승하거나 기존 안압에서 10 mmHg 이상 상승한 환자는 6명(18.8%)이었고, 안압 상승군에서 유리체강 내 덱사메타손 삽입술 후 안압이 상승한 시기는 평균적으로 첫 시술 후 5.9개월이었으며각각의 안압 상승 사건에서 안압 상승 직전 유리체강 내 덱사메타손 삽입술 시행 후 평균 1.5개월 후였다. 안압이 상승한 환자는 만니톨 정맥내 주사와 안압 하강 안약으로 안압이 조절되었으며 녹내장수술이나 레이저가 필요한 환자는 없었다. 결론: 안압 상승은 유리체강 내 덱사메타손 임플란트삽입술 시행 후 나타나는 중요한 합병증으로 시술 시행 후 초기에 나타난다. 안압상승의 과거력이 있더라도 반복적으로 꼭 재현되는 것은 아니며, 주의깊은 관찰과 예방적, 치료적 안압 하강 제제의 사용으로 이를 관리할 수 있었다.
Abstract
Purpose: To investigate the occurrence and increase in intraocular pressure (IOP) over time in patients with retinal vein occlusion treated with dexamethasone intravitreal implants. Methods: Thirty-two patients who met retreatment eligibility criteria received sequential intravitreal dexamethasone implant insertion for retinal vein occlusion in one eye, and were followed for 36 months (maximum of 10 injections) from February 2011 to March 2017. Patients without follow-up data at each investigation time point were excluded. Results: An IOP increase ≥ 10 mmHg from baseline or an IOP ≥ 25 mmHg occurred in 18.8% of the patients. IOP-lowering medications were used in these patients. The first IOP elevation occurred with a mean of 5.9 months after the first intravitreal dexamethasone implant insertion in the IOP elevation group, and with a mean of 1.5 months after previous intravitreal dexamethasone implant insertion in each IOP elevation event. No patients required laser or incisional glaucoma surgery during the study period. Conclusions: An increase in IOP occurred in the early period after intravitreal dexamethasone implant insertion, and did not occur in sequential insertion. Although an increase in IOP was a significant side effect of intravitreal dexamethasone implant insertion, the IOP could be controlled with careful observation and use of preliminary and therapeutic anti-ocular hypertensive agents.
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